Hydrocodone, Dihydrocodeinone -- (Vicodin, Lortab)

Introduction

Hydrocodone is an orally active analgesic and antitussive Schedule II narcotic that is marketed in multi-ingredient Schedule III products. Hydrocodone has an analgesic potency similar to or greater than that of oral morphine. Sales and production of this drug have increased significantly in recent years (a four-fold increase between 1990 and 2000), as have diversion and illicit use. Trade names include Anexsia®, Hycodan®, Hycomine®, Lorcet®, Lortab®, Tussionex®, Tylox®, Vicodin®, and Vicoprofen®. These are available as tablets, capsules, and/or syrups. Generally; this drug is abused by oral rather than intravenous administration. Currently, about 20 tons of hydrocodone products are used annually in the United States.

Hydrocodone abuse has been escalating over the last decade. There has been large scale diversion of hydrocodone. For example, an estimated 7 million dosage units were diverted in 1994 and over 11 million in 1997. In 1998 there were over 56 million new prescriptions written for hydrocodone products and by 2000 there were over 89 million. From 1990 the average consumption nationwide has increased by 300%. In the same period there has been a 500% increase in the number of Emergency Department visits attributed to hydrocodone abuse with 19,221 visits estimated in 2000. In 1997, there were over 1.3 million hydrocodone tablets seized and analyzed by the DEA laboratory system. A recent petition submitted to the DEA has requested a review of the control status of all hydrocodone-containing products.

Licit Uses

Hydrocodone is an effective antitussive (anti-cough) agent, and as an opiate it is also an effective analgesic for mild to moderate pain control. Five mg of hydrocodone is equivalent to 30 mg of codeine when administered orally. Early comparisons concluded that hydrocodone and morphine were equipotent for pain control in humans. However, it is now considered that a dose of 15 mg (1/4 gr) of hydrocodone is equivalent to 10 mg (1/6 gr) of morphine. Hydrocodone is considered to be morphine-like in all respects.

Chemistry/Pharmacology

Hydrocodone [4,5a-epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5), dihydrocodeinone] is a semisynthetic opioid structurally related to codeine and is approximately equipotent to morphine in producing opiate-like effects. The first report that hydrocodone produced a "striking euphoria" and habituation symptoms was published in 1923; the first report of hydrocodone dependency in the U.S. was published in 1961. It was removed from exempt status in the U.S. by the Narcotics Manufacturing Act of 1960.

There are over 200 products containing hydrocodone in the U.S. In its most usual product forms hydrocodone is combined with acetaminophen (Vicodin, Lortab), but it is also combined with aspirin (Lortab ASA), ibuprofen (Vicoprofen), and antihistamines (Hycomine). Both tablet and liquid forms of hydrocodone are available (e.g., Tussionex)

Hydrocodone will react as a normal opiate in the available field test kits.

Illicit Uses

Hydrocodone is abused for its opiate-like effects. It is equipotent to morphine in relieving abstinence symptoms from chronic morphine administration. The Schedule III status of hydrocodone-containing products has made them available to widespread diversion by "bogus call-in prescriptions" and thefts. Three dosage forms are typically found (5, 7.5, and 10 mg) and their behavioral effects can last up to 5 hours. The drug is most often administered orally. The growing awareness and concern about AIDS and blood-borne pathogens easily transmitted by syringe needle use, has made the oral bioavailability of hydrocodone attractive to the typical opiate abuser.

As with most opiates, the adverse effects of hydrocodone abuse are dependence and tolerance development. Its co-formulation with acetaminophen has also increased the likelihood of acetaminophen-induced hepatic necrosis with high dose acute dosing, but slow escalation of dose over time seems to protect the liver during high dose chronic exposures seen with this drug.

User Population

Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by professionals. Sometimes seen as a "white-collar" addiction, hydrocodone abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely hydrocodone abuser is a 20-40 yr old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, hydrocodone-related deaths have been reported from every age grouping.

Illicit Distribution

Hydrocodone-containing products are in tablet, capsule and liquid forms. A variety of colors, markings, and packaging are available.

The major source of hydrocodone to the street has been through bogus call-in and forged prescriptions, professional diversion through unscrupulous pharmacists, doctors, and dentists, and large-scale thefts. The pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.

Control Status

Hydrocodone is in Schedule II of the Controlled Substances Act. Preparations containing hydrocodone in combination with other non-narcotic medicinal ingredients are in Schedule III.